Value-Based Healthcare through Collaboration

On May 16th, the Faculty of Health Sciences at Queen’s and the Kingston Health Sciences Centre co-hosted a panel discussion entitled, “Value-Based Healthcare through Collaboration: How do we make progress?” The panel included industry leaders in healthcare from across the region who generously took the time to speak to our community. First and foremost, I would like to thank all of our panelists for their time, and I want to give a special thanks to Kevin Empey, the former Supervisor of Brockville General Hospital, for giving an insightful plenary address. The goal of this event was to better understand how we can extract more value in healthcare both from the procurement of major capital equipment and in the design of new technologies. The event was a great success, thanks primarily to our incredible panelists. The discussion has also left me thinking about some important questions concerning value, procurement, and healthcare in Canada.

For instance, how should we define value in the first place? In my view, value can be defined as that which something or someone does to make a material difference between the present and the future. There are economic examples of this, such as pricing that targets customer preferences and their respective willingness to pay. Love is another example, albeit of social value. When in a partnership, individuals extract benefits from the relationship that they appreciate and cherish. How greatly do we appreciate it when our partner makes us laugh, or when they make us feel better when we are feeling down? We appreciate these qualities in partners because they create value: they change our experience of life for the better.

It’s sometimes tempting for people to think that low prices and value are the same thing. For instance, it’s very easy to think that something that’s cheaper represents better value for a consumer. We can sometimes see this line of thinking in debates about healthcare.

But I don’t think we should care about low costs above all in healthcare. When discussing healthcare, we should think of value as patient outcomes per dollar spent. According to the Canadian Institutes for Health Information, hospital procurement accounts for 28.3% of all healthcare costs, which translates into approximately $13B worth of spends in Ontario alone. It would be easy to see this figure and use it as a basis for a decision to make cuts to healthcare. Such a decision, however, would strip away the potential for hospitals to realize improved outcomes for patients. Reducing capacity to procure would also mean that hospitals will be unable to adopt new technologies, thereby forcing healthcare organizations to fund capital equipment themselves through philanthropy – a scenario that challenges our principles of fairness.

Going forward, hospitals must collaborate with academia, physicians, industry, and patients to demystify what value in healthcare means for patients and its potential to make healthcare more cost effective. We must continue to have discussions like the one we hosted in Kingston so as to ensure that governments and people understand that value in healthcare is good public policy for all.

Thank you again to all those who participated in “Value-Based Healthcare through Collaboration.” Through discussions like that, we can help work towards maximizing the value of care provided to all Canadians.

Bill Moore, Queen's MD '62

Thanks Dr. Chitayat for your comments on this discussion at Queen's. Value vs. cost is an ongoing issue for everyone, about everything, everywhere. Regarding healthcare and the role of hospitals and physicians, what is the value of longer, good-quality life for individuals and preserving/improving that -- and who can afford/will pay for it?

Hospitals and physicians are caught between serving their patients as best they can amid the uncertainties of support. This is a festering problem as politicians come and go with their own priorities until they become old/injured/sick and expect the best healthcare for themselves/family, possibly after not supporting it. Insurance companies where I live in the US are becoming more controlling over who/what medications/treatments one gets -- like it is for their benefit, not those in need. Of course, personal wealth and philanthropy can help sustain the mission of physicians and hospitals and the well-being of their patients, but is that sustainable? For how long?

During my Dad's (Queen's MD '28) and my careers, this didn't seem to be as large a problem as it is today nor be as urgently needed for feasible solutions.

I'm glad you're stimulating debate and sincerely hope both healthcare improvements/funding will follow. All the best in your endeavors!